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Motivation and engagement during cognitive training for schizophrenia spectrum disorders.

ABSTRACT: Background:Motivation and engagement are important factors associated with therapeutic outcomes in cognitive training for schizophrenia. The goals of the present report were to examine relations between objective treatment engagement (number of sessions attended, amount of homework completed) and self-reported motivation (intrinsic motivation and perceived competence to complete cognitive training) with neurocognitive and functional outcomes from cognitive training. Methods:Data from a clinical trial comparing two cognitive training approaches in schizophrenia-spectrum disorders were utilized in the current report (n?=?38). Relations were examined between baseline intrinsic motivation, perceived competence, homework completion, and session attendance with improvements in neurocognition, functional competence, and community functioning. Results:Number of sessions attended (r?=?0.38) and time doing homework (r?=?0.51) were significantly associated with improvements in neurocognition. Homework completion was associated with change in community functioning at a trend-level (r?=?0.30). Older age was associated with greater treatment engagement (??=?0.37) and male biological sex was associated with greater self-reported motivation (??=?0.43). Homework completion significantly mediated the relationship between session attendance and neurocognitive treatment outcomes. Conclusions:Objective measures of treatment engagement were better predictors of treatment outcomes than subjective measures of motivation. Homework completion was most strongly related to treatment outcomes and mediated the relationship between session attendance and treatment outcomes, suggesting continued engagement with cognitive stimulation may be an especially important component of cognitive remediation programs. Future research should examine methods to improve homework completion and session attendance to maximize therapeutic outcomes.

SUBMITTER: Best MW

PROVIDER: S-EPMC6889769 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Motivation and engagement during cognitive training for schizophrenia spectrum disorders.

Best Michael W MW Milanovic Melissa M Tran Tanya T Leung Pauline P Jackowich Robyn R Gauvin Stéphanie S Leibovitz Talia T Bowie Christopher R CR

Schizophrenia research. Cognition 20190523

<h4>Background</h4>Motivation and engagement are important factors associated with therapeutic outcomes in cognitive training for schizophrenia. The goals of the present report were to examine relations between objective treatment engagement (number of sessions attended, amount of homework completed) and self-reported motivation (intrinsic motivation and perceived competence to complete cognitive training) with neurocognitive and functional outcomes from cognitive training.<h4>Methods</h4>Data f ...[more]

PMID: 31828022

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Project description:Autism Spectrum Disorders (ASDs) are characterized by core deficits in social functions. Two theories have been suggested to explain these deficits: mind-blindness theory posits impaired mentalizing processes (i.e. decreased ability for establishing a representation of others' state of mind), while social motivation theory proposes that diminished reward value for social information leads to reduced social attention, social interactions, and social learning. Mentalizing and motivation are integral to typical social interactions, and neuroimaging evidence points to independent brain networks that support these processes in healthy individuals. However, the simultaneous function of these networks has not been explored in individuals with ASDs. We used a social, interactive fMRI task, the Domino game, to explore mentalizing- and motivation-related brain activation during a well-defined interval where participants respond to rewards or punishments (i.e. motivation) and concurrently process information about their opponent's potential next actions (i.e. mentalizing). Thirteen individuals with high-functioning ASDs, ages 12-24, and 14 healthy controls played fMRI Domino games against a computer-opponent and separately, what they were led to believe was a human-opponent. Results showed that while individuals with ASDs understood the game rules and played similarly to controls, they showed diminished neural activity during the human-opponent runs only (i.e. in a social context) in bilateral middle temporal gyrus (MTG) during mentalizing and right Nucleus Accumbens (NAcc) during reward-related motivation (Pcluster < 0.05 FWE). Importantly, deficits were not observed in these areas when playing against a computer-opponent or in areas related to motor and visual processes. These results demonstrate that while MTG and NAcc, which are critical structures in the mentalizing and motivation networks, respectively, activate normally in a non-social context, they fail to respond in an otherwise identical social context in ASD compared to controls. We discuss implications to both the mind-blindness and social motivation theories of ASD and the importance of social context in research and treatment protocols.

Dataset Information

Motivation and engagement during cognitive training for schizophrenia spectrum disorders.

Publications

Motivation and engagement during cognitive training for schizophrenia spectrum disorders.

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